Licensure and Certification Application

Eligibility Requirements and Application
for
Licensure and Certification

Licensure/Certification will be awarded at three progressive levels:

Workshop. Workshop level licensure/certification can be completed entirely via the Internet. When licensed/certified at the Workshop level, the license/certificate holder must agree to use only approved templates for Workshop level license/certificate holders. The use of approved templates and the successful completion of continuing requirements at the Workshop level may result in licensure/certification at the Practitioner level.
Practitioner. The Practitioner level licensure/certification will be awarded to individuals who have competed the minimum successful templated presentation requirements and who have received the favorable recommendation of an assigned mentor to progress to the Practitioner level. Advanced topics for study and successful application include Matching Tasks with Talent guided coaching under the supervision of an assigned mentor.
Mastery. The Mastery level licensure/certification will be awarded to individuals who have exhibited successful sustained experience at the Practitioner level. Mastery level entitles the license/certificate holder to design workshops, license CapacityWare software and literature, and mentor others applying for Licensure and/or Certification.

Minimum eligibility requirements include:

MUST have attended an RGB Workshop presentation.
MUST have satisfactory experience as a group facilitator.
MUST select and work with a certified mentor. Click for list.
MUST complete the following application form.
MUST make the financial investment required or commit to an alternative plan such as a pay-as-you-go plan (identified in each certification step).
MUST secure application approval for access to appropriate on-line services.

Upon certification, CapacityWare may be licensed, or data processing work may be processed by QWLC or an eligible mentor-agent.

Licensure and Certification Application

PART A
Personal Information

A1. NAME:
A2. LINE 1 STREET ADDRESS:
A3. LINE 2 STREET ADDRESS:
A4. CITY: A5. STATE: A6. ZIP:
and/or
A7. PROVINCE: A8. COUNTRY: if not USA.

A9. EMPLOYER:
A10. PROFESSION:

A11. E-MAIL:
A12. FAX:
A13. WEB SITE:

A14. I MAY BE AVAILABLE FOR TEAMING WITH OTHER CERTIFIED INDIVIDUALS -
YES - NO - MAYBE .

A15. THIS APPLICATION IS INTENDED TO PURSUE THE FOLLOWING LICENSURE/CERTIFICATION LEVELS:
WORKSHOP, PRACTITIONER, MASTERY.

PART B
Connection or Introduction

B1. RGB OR RELATED WORKSHOP DATE(S): ,
B2. LOCATION: , and
B3. FACILITATOR(S) or TEAM:

B4. DESCRIPTION OF MOTIVATION TO ADVANCE RGB UNDERSTANDING:

PART C
Entrepreneurial Experience

C1. DESCRIBE THE Entrepreneurial EXPERIENCE YOU HAVE HAD WITH THE CLIENT BASE YOU PRIMARILY INTEND TO SERVE.

C2. DESCRIBE YOUR SUCCESSFUL EXPERIENCES IN MARKETING SOFT-SERVICES TO A SPECIFIC CLIENT BASE:

PART D
Computer Literacy and Current Applications Package(s)

D1. CERTIFY THAT YOU HAVE MS OFFICE SUITE (PROFESSIONAL VERSION) ON THE PRIMARY COMPUTER WHERE CAPACITYWARE SOFTWARE WILL RESIDE. YES or NO.

D2. PROVIDE A DETAILED STATEMENT THAT DESCRIBES YOUR LEVEL OF FAMILIARITY WITH THE ADVANCED FEATURES OF MS OFFICE PROFESSIONAL SUITE.

PART E
Facilitation Experience

E1. APPROXIMATE NUMBER OF GROUPS FACILITATED:
E2. DATE RANGE OF EXPERIENCE AS A GROUP FACILITATOR:
E3. REQUEST FOR WAIVER FOR THE FOLLOWING REQUIREMENTS (INCLUDE JUSTIFICATION):

PART F
Mentor Selection

F1. Please, assign an appropriate mentor.
F2. Please, assign the following mentor: Click for list.

PART G
Potential Certification Use(s)
(Select all that apply)

G1. My Business
G2. RGB Team Member
G3. Employer Use (I understand and have explained to my employer that Licensure and Certification is NOT employer owned.)

G4. For Profit Work
G5. For Non-profit Work

PART H
Financial Arrangements

H1. I have read and understand the financial obligation for this complete course of instruction leading to independent licensure and agree to 1/2 payment in advance upon receipt of invoice.

H2. I propose the following alternative financial arrangements.

PART I
Support Arrangements

I1. I intend to operate completely independently.

I2. I intend to acquire support services from QWLC or another authorized firm.

PART J
Professional Standards Acceptance
(Failure to accept and abide by these Professional Standards is cause for rejection or termination.)

J1. I accept these standards and agree to abide by them.

When the SUBMIT button is "clicked" I certify this constitutes my full application as identified herein.
You will be provided with a receipt for this submission. It is recommended that you retain a copy of this receipt for you files.

Eligibility Requirements and Application forLicensure and Certification

Licensure and Certification Application

Eligibility Requirements and Application
for
Licensure and Certification